1807 PREDICTORS FOR NEGATIVE URETEROSCOPY IN THE MANAGEMENT OF UPPER URINARY TRACT STONE DISEASE

Abstract

You have accessJournal of UrologyStone Disease: SWL, Ureteroscopic or Percutaneous Stone Removal III1 Apr 20101807 PREDICTORS FOR NEGATIVE URETEROSCOPY IN THE MANAGEMENT OF UPPER URINARY TRACT STONE DISEASE Jessica Kreshover, Rian Dickstein, Courtney Rowe, Richard Babayan, and David Wang Jessica KreshoverJessica Kreshover More articles by this author , Rian DicksteinRian Dickstein More articles by this author , Courtney RoweCourtney Rowe More articles by this author , Richard BabayanRichard Babayan More articles by this author , and David WangDavid Wang More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1732AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Although computed tomography (CT) scans are extremely accurate in assessing ureteral and renal calculi, there is an increased effort by urologists to limit CT scans and minimize radiation exposure. On occasion, patients undergo a planned ureteroscopy with laser lithotripsy and it is discovered that the stone has already passed. We sought to identify predictive factors of negative ureteroscopies from a large cohort of patients. METHODS A retrospective chart review was performed on all ureteroscopies performed by a single surgeon from August 2003 to May 2008 for renal and ureteral stones. Renal units were examined separately to include bilateral cases. Renal units were excluded for stone size greater than 10mm (given a low probability of spontaneous passage), staged procedures, and with previously placed ureteral stents given the need for repeat procedure. Negative ureteroscopies were then compared with those where stones were identified and treated. Factors including stone size, stone location, presence of pre-operative pain, time interval since CT, presence of hydronephrosis, and use of alpha-blockers as medical expulsive therapy (MET) were compared between the two cohorts using student's t-test, test of proportions, and analysis of variance. RESULTS A total of 256 ureteroscopies (97 bilateral) were identified (Table 1). Twenty five of 256 renal units (9.7%) did not have stones upon direct visualization. Comparing negative and positive cohorts, there was a significant difference in stone size (4.48 vs 6.78mm, p<0.001) and stone location (p=0.04). There were no significant differences between the two cohorts with respect to time interval from CT to surgery (p=0.65), presence of hydronephrosis (p=0.74), use of MET (p=0.21), or pre-operative pain (p=0.83). CONCLUSIONS Negative ureteroscopies were performed in almost 10% of renal units with a reasonable chance of stone passage. Our data suggest that smaller stone size and distal location are useful predictors for a negative ureteroscopy. Pre-operative pain, presence of hydronephosis, time interval until surgery, and use of MET did not correlate with negative ureteroscopy. Thus, patients who elect to undergo ureteroscopy with laser lithotripsy should be given informed consent about the possibility of undergoing a negative ureteroscopy. In addition, repeat imaging may be considered before surgery in patients with smaller and more distal ureteral stones. Boston, MA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e701 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jessica Kreshover More articles by this author Rian Dickstein More articles by this author Courtney Rowe More articles by this author Richard Babayan More articles by this author David Wang More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...